This article explores sciatica from the perspective of acupuncturists who witness the pain and discomfort it causes their patients in a clinical setting. We will look into what sciatica is, including its defining features and symptoms. Additionally, we will highlight the common causes of sciatica where acupuncture particularly excels in providing relief.
What is sciatica?
Sciatica is a complex of symptoms caused by compression or irritation of the sciatic nerve. These symptoms, typically affecting one leg, can include pain, weakness, numbness, or tingling that radiates down the back of the leg and may sometimes reach the foot and toes.
Sciatic nerve
The sciatic nerve is a combination of multiple nerves originating from both the lumbar and sacral regions of your lower back: L4, L5, S1, S2, and S3. The fibers destined to become the sciatic nerve merge to form a single. This newly formed sciatic nerve then travels down your buttocks, leg, and foot, carrying both sensory and motor information.
Symptoms
The characteristic of sciatica is that pain radiates along the course of the sciatic nerve, most often down the buttocks and posterior aspect of the leg to below the knee. It may occur with or without low back pain.
The feeling might be:
- Burning
- Tingling
- Stabbing
- Weakness or numbness in the affected leg
Activities like coughing, sneezing, or bending could worsen the pain. Patients may suffer from sensory, motor, or reflex deficits when nerve root compression exists.
Radiating pain vs. Referred pain
Sciatica’s hallmark is radiating pain. When the sciatic nerve itself or the root forming the sciatic nerve is compressed or irritated, pain radiates along the course of the sciatic nerve. If you feel pain on the buttock and at the back of the same side of the thigh, that is possibly the radiating pain. However, referred pain due to hip arthritis or a sacroiliac joint problem can cause similar pain in the same area. Therefore, Distinguishing radiating pain from referred pain is crucial for effective treatment.
To differentiate between the two, evaluations for sensory deficits, muscle weakness, and specific physical tests, for example, the straight leg raise (SLR) or negative SLR test, are conducted. Radiating pain typically affects a large area along the nerve distribution, unlike referred pain, which affects a relatively restricted area.
Common Causes of Sciatica
- Herniated disc: Herniated disc accounts for approximately 90% of the causes of sciatica. (Valat et al., 2010), and acupuncture is one of the effective methods in treating lumbar disc herniation (Tang et al., 2018)
- Piriformis syndrome: This occurs when the piriformis muscle presses on the sciatic nerve, an issue acupuncture is well-suited to address.
Other causes include:
- Spinal stenosis
- Bone-related issues – bone spur, spondylolisthesis
- Intraspinal tumor
Referred Pain Similar to Sciatica
Conditions that mimic sciatica but are also effectively managed with acupuncture include:
- Sacroiliac joint referred pain: Sacroiliac joint issues can cause localized and referred pain. The referred pain can appear on the buttocks and the legs.
- Facet joint referred pain: Irritated lumbar facet joints can cause pain or discomfort in the hip, buttocks, thighs, or even groin, like the image below. Please refer to our other post, “Hip Pain Originated from Lumbar Facet Joints”.
- Hip osteoarthritis: The groin, thigh, and buttocks are common areas that patients with hip arthritis express (Poulsen et al., 2015).
What Does Acupuncture Do?
The most common reasons that can cause sciatica are related to muscles, ligaments, and joints. These are where acupuncture shows effectiveness in treating with few side effects. If you’re dealing with sciatica, exploring acupuncture as a method to alleviate pain and address its root cause can be a beneficial option.
However, it’s important to note that acupuncture isn’t a cure-all. Surgery may be necessary in the following scenarios:
- Muscular weakness
- Progressive neurologic deficit
- Trouble in controlling urination or defecation
- Intolerable pain that interferes with job or personal functions in an emotionally stable patient and that has not lessened after 6 weeks of conservative treatment.
References
“Sciatica”
https://doi.org/10.1016/j.berh.2009.11.005
“Acupuncture for Lumbar Disc Herniation: A Systematic Review and Meta-Analysis”
https://journals.sagepub.com/doi/abs/10.1136/acupmed-2016-011332
“Pain distribution in primary care patients with hip osteoarthritis – A descriptive study”
https://www.oarsijournal.com/article/S1063-4584(15)00654-8/fulltext
DISCLAIMER – Link to the Whole Statement
While this blog offers helpful information, it’s not a substitute for medical advice. As individual’s health concerns are unique and require professional guidance, do not rely solely on online information for self-diagnosis or treatment. If you have health concerns, always consult a healthcare professional for personalized diagnosis and treatment.
